I'm Not in Denial: Reflection on The Kidney Incident

Yet I am not silenced by the darkness, by the thick darkness that covers my face. (Job 23:17)

I suspect in some instances my friends who visit me and see me in high spirits and bubbly think that I'm in denial of my situation. You see I have End-Stage Renal Disease more popularly known as Chronic Kidney Disease or CKD. And for me to be seen thankful at life is just a bit suspicious. The truth is I'm just thankful. Simple as that. Thankful.

Being grateful when one is sick may cause some people to roll their eyes. It’s understandable. There are many instances when a person suffering a major tragedy in life would sink into a state of denial and create an illusion of detachment. All one has to do is to deny that the tragedy never happened and that one lives a normal life.

Some might think that seeing the blessings of God in a living nightmare is just plain denial. It might be true, but not always. Unlike the person in denial who refuses to believe difficulty has befallen one, the truth of the matter is I know that my life is a cautionary tale. My life right now is travail compared to many a regular life. I rise before the dawning of the morning and cry for help that my body won't deteriorate the entire day. Every morning I still cut my Carvedilol into two and organize them in a pill box along with the Amlodipines, Ferrous Fumarates and Calcium Carbonates. Every three days I still go the National Kidney Transplant Institute to go through four hours of hemodialysis. A machine as big as a small refrigerator sucks blood from me, cleans it, and then pushes it back to my jugular vein through a plastic catheter that is buried inside my collar bone 8 inches down. Every time I complete a dialysis, I still get 4000 units of an Epo shot on my right arm to ward off anemia by buttressing my hemoglobin production. I am currently nursing a fistula on my left arm. A fistula is like a USB port for blood. Later doctors would remove my catheter, sew the opening up and stab my fistula with two big needles for my dialysis. Every session I have to shell out ₱4500 (that's ₱45,000 a month!). Add to that, everyday, I have to measure my salt intake and avoid eating oily foods and food cooked in coconut milk or gata (I’m a Bicolano and this is probably the worst of all!). Everyday I have to watch my blood pressure and avoid stress (50% of “Chronic Kidney Disease” or CKD patients die of heart disease). Me, in denial? No way!

My outlook nowadays is that my life will never be the same again. CKD is a game-changer. My present prescription tells me that I have to have dialysis for the rest of my life and that a kidney transplant must be in my future plans to save money and life. And even after I get a transplant I will still be regularly monitored by the doctor, be careful with my eating and take a good dose of medications. Everyday I have to fight off the dangers of depression, worry, fear, and anger and overwhelm them with enthusiasm & zeal for life. That last part though “enthusiasm & zeal for life” is a gift from God. While “depression, worry, fear, and anger” are my own doing, “enthusiasm & zeal for life” are gifts of God. To make things clearer: think of these two groups as having two different sources – one self-generated; the other graciously given.

 These were my reflections as I pondered on a Bible book that exemplifies living without denials. One would wonder why the writer of Lamentations wrote these perplexing lines:

 I remember my affliction and my wandering,
   the bitterness and the gall.
I well remember them,
    and my soul is downcast within me.
Yet this I call to mind
    and therefore I have hope: (3:19-21)

 Why would remembrance of “affliction” which certainly created in the writer a “downcast” feeling and yet he has “hope”? John Calvin asks the same question in his commentary to this passage. He asks,

How can despair produce hope from itself? This would be contrary to nature. What then does the Prophet mean here...? Even that being oppressed with evils, he was almost lost, and was also nearly persuaded that no hope of good anymore remained.

Being “downcast” many understand is a bummer. Many people think that being “downcast” is a source of depression and may lead to many medical issues such as heart disease, stomach and psychological problems. But I would suspect that that is the same number of people who would believe that hope has a role in recovery. In a landmark study on the role of hope on cancer patients PhD and RN authors, Dr. Tone Rustøen, Dr. Bruce A. Cooper and Dr. Christine Miaskowski in Cancer Nursing: An International Journal for CancerCare (Jan/Feb [2013] 36.1) most specifically in their article “The Importance of Hope as a Mediator of Psychological Distress and Life Satisfaction in a Community Sample of Cancer Patients,” their study concluded that “hope is an important resource for oncology patients that impacts their quality of life.”

Now I have a recurring struggle with cynicism. I question a lot. A question that comes to my mind for readers would be that I am just saying this to alleviate my suffering and create an illusion of calm and serenity. Actually I don’t want to repeat myself. I have already stated above the difficulty I face not only on a daily basis but all the time. The more I deny that reality, the more incapable I am of adapting to the situation. That’s why I try to avoid living in denial.

A person-in-denial’s life is a life that is grounded on an illusion. When one creates a life that is not there, what one creates is oftentimes grounded on an illusion, if not always. Hope for it to be hope must be grounded on nothing but the Ultimate Reality, God Himself. Calvin is best to explain what I’m talking about in his commentary on Lamentations 3:21:

As then he would recall this to mind, he says that he would then have new ground of hope, that is, when he had recourse to God; for all who devour their own sorrows, and do not look to God, kindle more and more the hidden fire, which at length suddenly turns to fury. Hence it comes that they clamor against God, as though they were doubly insane. But he who is conscious of his own infirmity, and directs his prayer to God, will at length find a ground of hope.

 Perhaps this was in the mind of the authors of the Westminster Confession of Faith when they wrote “a true believer may wait long and conflict with many difficulties before he be partaker of [infallible assurance].”

Now that is a long and winded way to explain yourself that you are not in denial. Please forgive me.

If you'd like to know more about this Hope I'm talking about and how to begin a life in Christ -- the "ground of hope" (most especially those going through tough times), drop me a note at jmpesebre@yahoo.com.

Kidney Edward beside a mechanical Bea.

Blessings in the Context of a Nightmare: My Kidney Story

January 15, 2013

Dear Friend,

You might have heard about my medical condition.

I am writing this note as a way of thanking my family and friends for the outpouring of love I received from last week's nightmare. In one of my FB statusses posted during the ordeal, I wrote "I thought my kidney problem would be the most life-changing moment of my life. Turns out it would be the love of friends that would prove life-changing." Those who visited me heard what happened but some of your have not had discomfort hearing my story.

Last week on my wife’s birthday (January 7, 2013), I learned from an ER doctor of our local hospital that I had to go through lifetime of dialysis. My acid reflux it seemed was on and off and I had frequent diarrhea. My wife and I went to this hospital’s emergency room where they received outpatients. I had just arrived from a 12-hour trip from Bicol trying to secure a ministerial employment. The morning I arrived, I was already very weak and very pale. My wife convinced me to go to the hospital because initially I wanted to have a birthday date for her at a Korean restaurant. My wife refused my wooing and persuaded me to go to the hospital. In the afternoon, we arrived at the FEU-NRMF and went through a series of tests. My ECG, the first of the two tests, was fine so the doctor asked for blood work. A few hours later, we got the results. I felt like a truck ran over me.

A normal creatinine level of people is around 100. Mine was 1,800! That is why I have to get a dialysis. A creatinine level of that magnitute means that my body is festooned with chemicals that are supposed to be discarded. It just had no way of getting out of me. The doctor told us that even a level 500 creatinine clearance, patients would have everything coming up silly. If my blood is not cleaned any moment, I would not have any control over my mind. The dialysis cleans my blood so that I will live a normal life like you.

My medical condition was brought about by chronic hypertension and unmanaged stress which have been virtually unchecked. This means I have to go to a hospital every three days to have my blood cleaned for four hours. The immediate fear for me was financial. A session costs 2-3 thousand pesos. If I need to go to the hospital for dialysis at that rate (10 sessions per month) I’ll be needing something not less than 30, 000 pesos medicines not included.

There were more than 120 visits I received in my weeklong stay at the National Kidney Transplant Institute (NKTI) where we transferred that day we learned I had to have dialysis. For the life of me I have never experienced feeling the kind of love I received from friends and family. It was the perfect antidote for the portents of dread this week had for me. The trip from the FEU-NRMF to NKTI was to me like a trip to hell -- with fear and dark anxiety gripping my heart. It was dinnertime and we were in a rickety taxi -- Mhai, Jotham, little Biboy and me. I was hungry, nauseaus, and most of all scared cold. It was hard to cry. I do not know. I did not want my son see me crumble. When we arrived NKTI friends  -- our Homebuilders Bible study group – assisted us. There were many pale and sickly people waiting in the lobby. I looked worse -- ragged, confused and watery eyes. When the hospita finally checked me in a room, our friends prayed over me and they left. An hour later, my wife left also to tend to our infant who was not allowed inside the hospital. My son Jotham spent the night with me. My wife returned midnight and told me that she asked one of our Homebuilders family to care for Biboy the entire night so she could spend the night with me also.

At 3 o'clock in the morning of Tuesday (January 8) a nurse wheeled me out my room on a wheelchair and I was ushered through the dark, long and freezing alleys (NKTI has centralized aircondition) onto the operating room where a doctor will put me under the knife. Near my right shoulder blade, the doctor opened me up and inserted an 8-inch catheter into my jugular vein to prep up my first dialysis experience. Yes there was local anesthesia and the room was very quiet -- no shouting, no restrained patient -- just the deafening screams inside my heart.

It was during that time that I made a resolution.I did not have to go on with life like this. I remembered that two days ago, Sunday, I preached three sermons on Lamentations 3:22-24

Because of the Lord’s great love we are not consumed,
    for his compassions never fail.
They are new every morning;
    great is your faithfulness.
I say to myself, “The Lord is my portion;
    therefore I will wait for him.”

In that sermon, I challenged the congregation. Little did I know that I would have to make that challenge to myself. Right here, right now. Somehow while sprawled on that table with a patch of anesthesia on my shoulder and a doctor holding off spurts of blood from my jugular vein, I had an epiphany: Because of the Lord’s great love we are not consumed, it said.

When the doctor was done, she stitched me up and instructed me back to my wheelchair which a nurse again pushed to the waiting room as the doctor cleaned up the operating table. It was 4 o’clock in the morning and much of the hospital lights were off making the place a bit dark. The nurse parked my wheelchair fronting the next patient – a 39-year old woman and a first time dialysis patient. She had the face of death. This was probably how I looked awhile ago. I comforted her by calling her “Classmate” and tried to make her smile: I was back to my old self and the beginning of many memorable blessings in the context of a nightmare. When she was finally wheeled to the operating table, she winked me a smile.

I had more than 120 visits from January 8-15 with an average of 20 per day. Almost all of them handed me money before they left and that helped us afloat. For the life of me I have never experienced feeling this love and joy from friend and family, to tell you the truth. We were literally carried through by the love of people. I told my wife that had if it not had been for them, I would have descended into a deep despair so dreadful to even imagine. A group of pastors decided to chip in. My high school classmates decided to be generous. I was visited by my seminary president, two denominational heads, quite a number of senior pastors, my old church in Marikina, my present church in Cavite, seminary classmates and schoolmates, my students, former students, colleagues, my wife’s college classmate (!), and even an enemy who incidentally was my first visitor. Well, he was an enemy in a coldwar sense. This was not of a violent nature. He apologized for what happened to us before and I gave him a hug.

So you see, this was my blessings in the context of a nightmare. Why nightmare? Well because I was diagnosed with End-Stage Renal Disease (ESRD) secondary to Hypertension – a real life-changer. When you see me I would look normal. My kidney failure did not give me the typical symptoms of bloating and dark skin (I already have dark skin to begin with!). I’m just the same John who is still very lively because of the many blessings he has received from God that week when it was supposed to be a week of dread and dismay. I am not in denial. You will know when you are in denial because you will feel strange. I am just thankful that God made me understand a little bit about how beautiful His gifts are. I am thankful that

Thou [O Lord] hast turned for me my mourning into dancing: thou hast put off my sackcloth, and girded me with gladness (Psalm 30:11)

I was discharged this afternoon from the NKTI and I spent my first dinner with the entire family for the first time since the nightmare. I opened the family prayer with these words:

Because of Your great love we are not consumed

Sincerely yours,




John, bad kidney